Lege Artis Medicinae

[Spiritualism in Medicine: a Benefit or a Hindrance? – Remembering Mária Kopp ]

PIKÓ Bettina

NOVEMBER 22, 2012

Lege Artis Medicinae - 2012;22(10-11)

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Lege Artis Medicinae

[Is postmenopausal hormone therapy suitable for cardiovascular prevention?]

LÁSZLÓ Ádám

[After menopause, coronary disease and infarction become increasingly common in women owing to estrogen deficiency. Therefore, hormon replacement therapy (HRT) had been widely used to prevent these problems and manage postmenopausal symptoms. In 2002, a large, randomised, placebo-controlled study reported that HRT was accompanied by serious side effects and was not suitable for cardiovascular prevention. However, subsequent re-alanyses of the data of this study and new studies in the past 10 years suggest that in women younger than 60 years and if started within 10 years after the menopause, HRT has a number of advantages and very few disadvantages. It substantially improves quality of life, while the absolute risk of side effects is small, and HRT is suitable for the primary prevention of coronary diseases. I summarise the cardiovascular aspects of menopausal hormone therapy, in order to help the necessary paradigm shift in this matter.]

Lege Artis Medicinae

[Daumier and Cézanne – Exhibitions in Budapest]

NAGY Zsuzsa

Lege Artis Medicinae

[What is the role of general praticioner in prevention of gastrointestinal tumours?]

MAGYAR Anna

Lege Artis Medicinae

[Picturing Birth in 20th and 21st Century Graphic Arts ]

SZABÓ András

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[Treatment of hypertension with carvedilol, new results]

LIPTÁK Judit

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Lege Artis Medicinae

[THE TREATMENT OF ACUTE ISCHEMIC STROKE BASED ON CURRENT GUIDELINES]

SZEGEDI Norbert, MAY Zsolt, ÓVÁRY Csaba

[Cerebrovascular diseases are third among the most frequent causes of mortality in developed countries and represent the most common cause of disability in adulthood. 80% of all acute stroke cases are of ischemic origin. The proven significant efficacy of intravenous thrombolysis with rt-PA in the NINDS rt-PA Stroke Trial was the cornerstone of the treatment of acute ischemic stroke, followed by several recommendations. From this time on, the attention shifted to early and appropriate recognition of symptoms and to organizing a quickly reacting emergency medical system in order to maximize the number of those patients transported immediately to the nearest stroke center to have the opportunity to be treated within three hours after their symptom onset. Specialized stroke facilities have documented benefit over other forms of stroke management concerning survival rates, but they need coordinated continuous multidisciplinary care for the patients, availability of CT scanner, laboratory examinations including tests of hemostasis, intensive care unit and well-trained stroke neurologists on 24-hours-a-day basis. Thrombolysis in these stroke centers with intravenous 0,9 mg/kg rt-PA improves the outcome of acute stroke with 30%. Although new guidelines strongly recommend the thrombolysis of selected ischemic stroke patients, the only evidence-based treatment of this condition has not yet become a part of the routine stroke management in Hungary. Regarding other specific antithrombotic therapeutic approaches, anticoagulation has the most contradictory status: in spite of well-defined theoretic considerations there are no evidence-based data in favour of routine anticoagulation in acute ischemic stroke, neither with heparin nor with low molecular weight heparins or heparinoids, while aspirin given within 24-48 hours after stroke onset was shown to have a significant but modest benefit. No data support the treatment with hemodilution or the administration of neuroprotective drugs. Evidence accumulating continuously determine the principles of general care including the methods and the targets in the acute phase of ischemic stroke regarding respiratory and cardiac care, management of blood pressure and blood glucose levels and body temperature.]

LAM Extra for General Practicioners

[USE OF DRUGS FOR GASTRIC ACID REDUCTION IN GENERAL PRACTICE]

HAJNAL Ferenc

[In order to facilitate (general) practitioner’s therapeutic decisions, this overview reviews advantages and disadvantages of three drug classes used for acid reduction, as to antacids, histamine 2-receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). The possibilities and mechanisms of gastric acid reduction are detailed. This can be achieved either by neutralization of gastric acid by systemic or non-systemic antacids, or by inhibiting acid secretion by H2RAs and PPIs. PPIs are the strongest acid reducing agents indispensable in gastro-esophageal reflux disease (GERD), eradication therapy for Helicobacter pylori ulcers and Zollinger- Ellison syndrome, and they are first choice in non-steroidal anti-inflammatory drug (NSAID) induced gastropathy, epigastric pain syndrome, and functional upper GI dyspepsia. Nonetheless, antacids and H2RAs are faster in relieving pain in the latter pain syndrome and in acute heartburn. Contraindications and adverse effects of these three drug classes are also detailed. The author has concluded that physicians’ up-to-date awareness of these compounds’ pharmacological properties contributes to their ability to tailor acid reduction therapy to patients’ individual needs. Refreshing and expanding this knowledge will finally benefit patients seen in everyday practice.]

Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

Hungarian Radiology

[Initial experiences with TOF MR and contrastenhanced MR angiography of the supraaortic arteries]

TASNÁDI Tünde, KARDOS Klára

[INTRODUCTION - 95 MR angiographic examinations of the supraortic arteries were performed at the Rethy Pal Hospital, Bekescsaba between February 2003 and May 2005. The aim of this publication is to analyse the clinical benefit of contrast-enhanced MR angiography compared to duplex ultrasound and to evaluate the role of TOF MR angiography in the diagnostics of the carotid arteries. We compared the results of contrast-enhanced MR angiography, TOF MR angiography and duplex ultrasound. MATERIAL AND METHOD - 95 patients were examined by CE MR angiography following carotid duplex US in 59 cases and TOF MR angiography in 88 cases. Duplex US was done using LOGIQ 400 PRO system, MR angiography were performed by 1.5 T Siemens Magnetom Symphony unit. RESULTS - Stenosis of the internal carotid artery was confirmed in 67 cases and stenosis of the common carotid artery was seen in 10 cases. Bilateral ICA stenoses were detected in 17 patients and bilateral CCA stenoses could be revealed in 3 cases. The ICA stenosis was mild in 22 (33%), moderate in 18 (27%), and serious in 27 cases (40%). Occlusion was seen in 10 cases (15%). CE MR angiography showed stenosis at the origin of the CCA in 5 patients, at the origin of the vertebral and the subclavian artery in 10-10 cases that could not be detected by duplex ultrasound. Subclavian artery stenosis was seen in 15 patients, 7 of them presented subclavian steal syndrome. 13 patients had vertebral artery stenosis, 7 of them bilateral. 13 of the 20 VA stenoses were mild, 4 were found to be moderate and 3 were serious. In four patients the vertebral arteries were occluded. In six questionable cases MR angiography solved the problem. Reversed flow could be detected in 5 cases with duplex ultrasound suggestive of subclavian steal syndrome, which was later confirmed by TOF and CE MR angiography. TOF MR angiography showed stenosis on reconstructed images, which was not confirmed by neither duplex US or CE MR angiography. Paraganglioma was detected in one patient. CONCLUSION - In case of calcified plaques and abnormal arterial-course CE MR angiography contributes significantly to the detection of the stenosis. In cases with moderate and serious stenosis duplex ultrasound and MR angiography provided similar results. In case of occlusions the results of the two modalities were the same. The contrast-enhanced MR angiography gives the possibility to show the aortic origin of the supraaortic arteries in contrast to the duplex US and TOF MR angiography. To establish the diagnosis of subclavian steal syndrome the directional sensitivity of TOF MR angiography and duplex US is helpful adjunct to CE MR angiography.]

Clinical Neuroscience

[Our clinical experience with zonisamide in resistant generalized epilepsy syndromes]

KELEMEN Anna, RÁSONYI György, NEUWIRTH Magdolna, BARCS Gábor, SZŰCS Anna, JAKUS Rita, FABÓ Dániel, JUHOS Vera, PÁLFY Beatrix, HALÁSZ Péter

[Purpose - Zonisamide is licensed in the European Union for adjunctive therapy for partial epilepsy, but its efficacy in generalized epilepsy was less explored. Methods - This prospective observational study included 47 patients (mean age 29 years, range 3-50) with different resistant generalized epilepsy syndromes: idiopathic generalized syndromes (IGE) 15 patients, (juvenile myoclonic epilepsy four, absence epilepsy four, myoclonic absence two, unclassified IGE five), progressive myoclonic epilepsy type 1 (PME1) four, severe myoclonic epilepsy of infancy (SMEI) three, borderline SMEI three, Lennox-Gastaut syndrome/secondary generalized epileptic encephalopties 23 patients. All patients were followed up for at least six months. The mean dose given was 367 mg/day (range 100-600 mg/day), the patients received at least one and no more than two concomitant AE. Response was defined as more than 50% seizure reduction or seizure freedom. Results - The best effect was achieved in PME one, all the patients were responders. Myoclonic seizures were reduced 80%, none of the patients had generalized tonic clonic (GTC) seizures. In two of the four patients all other antiepileptics were tapered of (including piracetam), so they were GTC seizure and almost myoclonia free on zonisamide only. Responder rates were in GEFS ± SME 62.5%, in resistant IGE 62.5%, and in epileptic encephalopathies 33.3% patients. Tolerance after initial efficacy developed in six patients. Adverse effects were mild: weight loss, somnolence and confusion were repeatedly reported. Three patients reported cognitive improvement. Conclusion - Clinical benefit of a broad spectrum antiepileptic zonisamide extends across seizure types, ages and epilepsy syndromes. The efficacy in PME proved to be excellent.]